Obstetric Vesico-vaginal Fistulae: A Documentary Review of Women Managed in Mendefera Zonal Referral and National Fistula Hospital, Eritrea

Dawit Sereke,Dawit Estifanose,Habte Hailemelecot,Yirgalem Issak

doi:10.11648/j.sjph.20200805.13

Abstract

Background: obstetric fistula is a devastating childbirth injury as a result of obstructed labor. It leads to chronic urinary incontinence and, in most cases, significant physical and emotional suffering. Its prevalence is high in Sab-Sahara African and South Asian countries. The objective of this study is to determine the incidence and describe the characteristics of women with obstetric Vesico-vaginal fistula. Methods: A retrospective cross-sectional study was conducted in all obstetric vesico-vaginal fistula patients. Patient identification performed through review of prerecorded logbook and patient card describing each patient admitted to fistula ward over a period of five years from January 1st 2014 to December 31, 2018. Medical records were reviewed to obtain data on socio-demographic and obstetric characteristics, clinical details, and treatment. Statistical analysis was performed using STATA-9. Results: There were 146 women with Vesico-vaginal fistula (VVF) admitted to the fistula hospital over the study period; of which 144 of them were obstetric fistula. During the study period the total number of health facility deliveries in Eritrea was 217,119 giving an estimated rate of obstetric VVF of 0.7/1000 facility deliveries. The median age, parity, and number of live births was 30, 3, and 2, respectively. One quarter (n=37) of the cases being in the age group of 20years or younger. The highest incidence of VVF (38%) was observed in Primiparous. 75% gave birth in a health facility, 54% of deliveries were by caesarean section, and 80% of babies were stillborn. 77% of repairs were successful. Conclusion: The incidence of fistula in Eritrea is relatively low as compared to other sub-Saharan African countries. In this study, age at fistula development was older than usually found, which might be due to poor access to emergency obstetric care (EmOC) that contributed more to this problem.

Highlights

IntroductionAdditional 20–30 women develop serious pregnancy-related complicati4ons [1]
For every maternal death, additional 20–30 women develop serious pregnancy-related complicati4ons [1]
There were 146 women with Vesico-vaginal fistula (VVF) admitted to the hospital over the study period; of which 144 of them were obstetric fistula and the rest two were related to gynecological operation

Summary

Introduction

Additional 20–30 women develop serious pregnancy-related complicati4ons [1]. Obstetric fistula (OF) is one of the most devastating conditions caused by injury during childbirth resulting in urinary and/or fecal incontinence [1,2,3]. World Health Organization (WHO) defines obstetric fistula (OF) as an abnormal connection between the vagina, rectum and/or bladder which may develop after prolonged and obstructed labour and lead to continuous urinary or fecal incontinence [2]. Vesico-vaginal fistula (VVF), a subtype of female urogenital fistula (UGF), is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. Recto-vaginal (RVF) is an abnormal fistulous tract between the vagina and rectum that allows continuous fecal leak (1-3). Over 90% of fistulas in low and middle income countries (LMIC) are of obstetrics

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Discussion

Conclusion